Basic Information
| Provider Information | |||||||||
| NPI: | 1487819843 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GRACI | ||||||||
| FirstName: | CHARLES | ||||||||
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| NamePrefix: | MR. | ||||||||
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| Credential: | PTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1255 5TH AVE | ||||||||
| Address2: | SUITE 6L | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100293852 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9144001500 | ||||||||
| FaxNumber: | 9144788781 | ||||||||
| Practice Location | |||||||||
| Address1: | 1015 SAW MILL RIVER RD | ||||||||
| Address2: | |||||||||
| City: | ARDSLEY | ||||||||
| State: | NY | ||||||||
| PostalCode: | 105021118 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9144001500 | ||||||||
| FaxNumber: | 9144788781 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/25/2008 | ||||||||
| LastUpdateDate: | 07/25/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | 006447 | NY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.